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Utah Business

COVID-19 exposed great flaws in our mental health care system, and as things continue to change, it will only get worse. Here's how you can help your employees.

What you should know about your employees and their mental health

COVID-19 has compounded existing pain points for how we handle mental health in our country. In the coming days, as our crisis management eases into a “new normal,” we are beginning to figuratively crawl out of our bunkers and assess the real situation. My goal is to sound a warning you’re not quite ready to hear: the predicted “second wave” of the pandemic will be exacerbated by the fact that as a state, our mental health was already fragile. Due to the fallout effect COVID-19 has had our workers’ mental health, we are unprepared as a state to handle this second pandemic just as surely as we lacked face masks during the first.

In terms of access to mental healthcare, we lagged far behind our peers prior to COVID-19. Between lapses in policy, general stigma, and ignorance, Utah is uniquely unprepared to give its residents access to affordable mental healthcare – and we are about to reap the whirlwind. We’ve become accustomed to looking for silver linings as this pandemic has forced us to re-examine everything from how we spend our time in isolation to how efficiently we can communicate when we aren’t face-to-face. The good news is that we do have the opportunity to drastically improve access to mental health care in our state if we have the will to start talking openly about the problem and eliminating outdated barriers to treatment. 

Utah’s dirty little secret

Utah’s suicide rates are unacceptable. From 2016 to 2018, Utah had the fifth-highest age-adjusted suicide rate in the nation. We can’t routinely tout our state as one of the healthiest in the nation while ignoring the fact that more than one in five Utah high school students considered attempting suicide last year. This is part of a systemic problem, and a concerted effort is required to tackle it. Keeping sight of this, especially during the global pandemic, is extremely important. We can do so by taking on the following tasks: 

Task #1: Change our public perception of treating mental health

Very few of us are celebrating every dentist visit, but we know if we skip too many, or wait until the pain is unbearable, the overall cost explodes. Some folks only need to visit the dentist a couple of times a year, while others may need more intensive work – but we do not stigmatize this type of care. We see it as normal, necessary hygiene. When mental health is afforded the same kind of respect, we’ll get a lot better at providing it. 

The great news is that more and more employers seem to understand the value of increasing access to mental health resources for their employees. This trend should continue long after we make it through the pandemic. 

Task #2: Increase access by reimagining teletherapy

Several years ago, as the cofounder of a growing startup, I found that I was experiencing anxiety in a way that felt different. I knew I needed to find help before my anxiety significantly impaired my ability to make contributions in my workplace. 

I went to my insurer’s website and downloaded a list of therapists within driving distance from my home. I then spent hours and hours calling the listed phone numbers and leaving voicemail after voicemail, occasionally getting through to an office administrator who would politely explain that their clinic specialized in therapy for eating disorders, or wasn’t accepting new patients, or had stopped accepting my insurance and therefore wouldn’t be able to take me on as a new patient. After weeks of searching, just when I had almost given up, I finally found a therapist that charged $150 per hour and would be willing to meet with me via Skype at 7 am. 

Most employers have no idea that even though they offer generous health insurance benefits to their employees, finding mental healthcare is still uniquely difficult in Utah. It requires a significant level of tenacity — something that’s often lacking when you are in a mental health crisis. Add to this the concern that due to high deductible health plans, most expenses will be out-of-pocket, and it’s easier to understand why so many people fail to seek appropriate care. 

Embracing better tools available for care

One benefit of the current pandemic is that most of us are far more conversant with video conferencing technology than we were three months ago. This bodes well for the future of mental healthcare because many of us have come to understand that we don’t have to be in the same room with someone in order to communicate at a deep level.

Simply eliminating the “commute” to a doctor’s office constitutes a seismic shift in access to care. Schedules are easier to coordinate, you don’t have to take time off work to attend, and the stigma of visiting a physical office is eliminated. Patients are 30 percent more likely to cancel an in-person appointment compared to a telephone or web appointment. It’s just that much easier to keep an appointment when you don’t have to leave your bedroom to attend — something important to consider when we are talking about healthcare concerns like depression and anxiety.

The truth is, teletherapy was already making headway long before COVID-19. Industry data has shown that 15 sessions of teletherapy are just as effective as 15 sessions of in-person therapy. 

Task #3: Create a telemedicine parity law

If we have known for so long that telemedicine works with equal effectiveness as in-person therapy, and is more convenient for patients, why has it taken so long for it to be adopted?

One major barrier is Utah’s lack of a telemedicine parity law. A parity law would require insurance companies to reimburse for telemedicine care at the same rate they would for in-person appointments. This means that many private and public insurance providers in Utah will pay a doctor, psychologist, or therapist significantly less for a virtual visit than an in-person visit. Since most clinicians aren’t anxious to make less money for providing the same service, very few have adopted virtual visits as part of their practice.

To date, 37 states have adopted parity laws, but Utah is among the 13 holdouts. Because of this, there were fewer clinicians prepared to deliver care virtually when COVID-19 hit, leaving our clinical staff scrambling when shelter-in-place orders were given. One way to make lemonade from the lemons of Coronavirus is to begin encouraging virtual health from a regulatory standpoint, rather than discouraging it.

By acknowledging the pain points for patients and making changes toward more accessible care (including via telemedicine), we’d be encouraging more people to take an active role in their mental health.

COVID as an accelerant

Unsurprisingly, COVID-19 has further strained all of the problems we’re facing, and finding care is especially challenging now. Providers are feeling the pressure, and the isolation is having a tangible effect on all of us. Perhaps the truly positive element is that the pandemic has become an accelerant for finding new and creative solutions to our mental health crisis, especially in Utah. The demand for telehealth is doubling as feelings of isolation, stress and anxiety are at an all-time high. Just before the lockdowns began, we were beginning to see a more significant push in legislation to improve the condition of our mental healthcare, and employers can help by continuing to support those efforts, insisting on attention from our legislators, and stepping forward to be a small part of the larger solution by talking openly about mental health within your organization.

The major challenges facing Utah’s mental health are also major opportunities for change. The challenge has never been more significant, but we have also never been better equipped to tackle it. By confronting the structural flaws in how we make patients navigate their healthcare, and by embracing the advantages of new solutions for care, we can open the way to a healthier and happier Utah. 

Dallen Allred is the co-founder and CEO of Tava Health, an online mental health company that partners with employers to provide convenient, accessible mental health resources to employees. Prior to co-founding Tava Health, Dallen co-founded Artemis Health, a healthcare data and analytics company that gives employers insights into their healthcare benefit utilization. Allred studied economics and American studies at Brigham Young University.

Comments (3)

  • Avatar

    Wendy Hacking

    Hi Dallen,

    I hope these online sessions make do not make patients feel more isolated in the long run. Getting out and interacting with the public is a very important part of fitting into the community. I’ve noticed utah has a hard time understanding these issues and will just create more distance from having to learn about medically complex neurological patients and their needs.

    I worry that their therapist may be one of the few people someone isolated with neurological issues ever interacts with. Especially when they are in a crisis. While this might be useful at times. I would hate to see doctors use this as a tool to distance themselves from the patients that they treat with medically complex mental health issues.

    It’s very interesting you mention the money and that the doctors might not even do this much without proper compensation. It’s always about the money.

    Best,
    Wendy Hacking

    reply
  • Avatar

    Christy Allen

    Very good points in your article.
    I did not know about the parity law, but that explains a lot about why we haven’t moved forward with virtual appointments in this state.
    I’d be happy to help lobby for this law to change in the next legislative session.

    reply
  • Avatar

    Bryan Zitzman

    Thank you for your thoughtful article Dallen. I particularly appreciate your acknowledgement of problems while focusing on solutions. As noted, we are continuing to see research findings that underscore the effectiveness of teletherapy when compared to in-person therapy. I recently attended a training on telehealth and trauma treatment. Not only did they acknowledge this research but they also showed how protocols for treating trauma required very little modifications in order to effectively deliver those protocols through teletherapy. From my experience and perspective, there are pros and cons to teletherapy. But there are also pros and cons to in-person therapy. And in many cases, the pros of teletherapy outweigh the cons.

    reply

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